Imipramine

About Imipramine

The label says imipramine’s mechanism is not definitely known; its effect is thought to come from blocking the reuptake of norepinephrine at nerve endings. The tablets are labeled for depression and, once other causes are ruled out, as temporary added therapy for bedwetting in children 6 and older; the pamoate capsules are for depression only, and their label recommends against use in children because their high strengths raise the danger of an overdose. Adult outpatients usually start at 75 mg a day, raised to 150 mg, with more than 200 mg not recommended; teenagers and older adults start at 30 to 40 mg a day and generally need no more than 100 mg. For bedwetting the dose is 25 mg an hour before bedtime, raised after a week if needed to 50 mg under age 12 or up to 75 mg over 12, never above 2.5 mg per kg a day. Once the dose is settled, the capsules can be taken once a day, at bedtime.

The boxed warning says antidepressants raised the risk of suicidal thinking and behavior in children, teenagers and young adults in short-term studies, so everyone starting one is watched closely for worsening mood, suicidal thoughts or unusual changes in behavior. The box also says imipramine is not approved for use in children, although the tablet indications include bedwetting from age 6, and the label says its safety and effectiveness in children have not been established for any other use. It is never combined with an MAO inhibitor or started within 14 days of stopping one, and it is not used while recovering from a heart attack; the pamoate label also rules out starting it in someone on linezolid or intravenous methylene blue, because of serotonin syndrome. Warnings cover use in heart disease, angle-closure glaucoma, low sodium, seizures, urinary retention and a switch into mania in undiagnosed bipolar disorder. MedlinePlus lists nausea, drowsiness, dry mouth and constipation among the common side effects, and it can make the skin sensitive to sunlight.

Deaths can occur from overdoses of this class of medicine, and children have been reported to be more sensitive to an overdose than adults, so the label says prescriptions should be written for the smallest amount feasible. Stopping suddenly after long use can cause nausea, headache and a general unwell feeling, so the prescriber lowers the dose gradually. MedlinePlus advises that adults 65 and older usually should not take it. Tofranil-PM is listed by the FDA as discontinued for reasons other than safety or effectiveness, and DailyMed shows no active listing for Tofranil tablets.

Taking Imipramine

How to take it

For depression, one or more times a day at about the same times, with or without food, as prescribed; once the dose is settled the capsules can be taken once a day, at bedtime. For bedwetting, the tablet is taken an hour before bedtime. Do not stop it suddenly; the prescriber lowers the dose gradually.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

At room temperature, tightly closed, away from heat and moisture, out of reach of children, who are more sensitive to an overdose than adults. Use a take-back program rather than flushing it.

Interactions to know about

MAO inhibitors must never be combined with it. SSRIs such as fluoxetine, sertraline and paroxetine, and quinidine and cimetidine, can raise its levels, and after fluoxetine at least five weeks may be needed before starting it. Decongestants and local anesthetics containing epinephrine or norepinephrine are avoided, and alcohol adds to drowsiness. Limit strong sunlight, and tell the surgeon or dentist about it before any procedure.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Imipramine differs from pharmacy to pharmacy

The hydrochloride tablets are an old generic from several makers, so quotes depend mostly on the pharmacy’s fee and markup, and a 150 mg dose made from 50 mg tablets is three tablets a day. The pamoate capsules come from only a couple of makers.

Capsules and tablets are different salts and dosage forms that are not rated as equivalent, so a pharmacist cannot swap one for the other without the prescriber. For a short bedwetting course, the dispensing fee is much of the price.

Ways to pay less for Imipramine without insurance

• Ask whether imipramine tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If the capsules are quoted high, ask the prescriber whether the same daily dose as tablets would suit you.
• Once your dose is stable, ask the prescriber whether a ninety-day supply is appropriate; it is not a controlled substance.
• If cost or side effects are a problem, ask the prescriber whether another generic antidepressant would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Imipramine

1. 1.Which mood or behavior changes in me or my child mean I should call right away?
2. 2.Is it safe with my other antidepressant, cold medicine or any MAO inhibitor I have taken?
3. 3.How long should my child take it for bedwetting, and how is it stopped?
4. 4.Should I have an eye exam before I start, because of the glaucoma risk?

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